Understanding any kind of insurance can be confusing and frustrating – especially dental insurance. You may be thinking it’s just like medical insurance, but that is far from the truth. Let us explain.
Dental Insurance: What Does “Maximum” Mean?
When referring to medical insurance, “maximum” generally refers to the maximum amount you would have to pay out-of-pocket per calendar year. For example, if you have an out-of-pocket maximum of $2,000, once you have spent a total of $2,000 on deductibles, copayments and coinsurance, your health plan will pay a 100% of covered benefits.
Now, when referring to “maximum” in regards to dental insurance, it’s a completely different ball game. Generally, most dental insurances have maximums of $1,500 to $3,000. If you have a maximum of $2,000, this means your dental insurance will only pay up to $2,000 for any given covered dental treatment. After this maximum is met, you are responsible for 100% of your dental treatment costs.
Let’s break this down a little more so we can help you better understand how your dental insurance works. An average person will have dental insurance that provides the following coverage:
Maximum of $2,000,
100% coverage on diagnostic and preventive procedures (i.e., exam and X-rays)
80% coverage on basic treatment like fillings,
50% coverage on major treatment like braces, crowns and bridges.
What do all of these numbers mean? Let’s explain!
Now, let’s assume that during your check-up, the dentist determines you have a cavity that needs a filling. For the filling, you would be paying a total of approximately $90. The breakdown is as follows: $50 deductible plus $40 copay (20% of $200 – which is the approximate cost for a filling).
On average, root canal treatment in Houston costs approximately $1,300. Since your plan covers 80% of the cost for Endodontic treatment, you will be paying approximately $300 out of pocket for the root canal. Suppose your dental insurance plan has paid out approximately $1,500 for your dental treatments – you now have $500 left before you reach your “maximum” and are then responsible for 100% of any further dental work needed.
Again, the above is just an example of what an average dental insurance plan and treatment costs looks like. Dental plans vary quite a bit – some cover a higher percentage and some cover a very low percentage.
You might be thinking – well, then some dentists may be charging an unreasonably high price! This is not the case. Dentists receive fee schedules from dental insurance companies, which helps a dentist determine how much they will be charging for any particular procedure.
We hope we have made it a little bit easier for you to understand how dental insurance in Houston works.
Understanding your dental treatment and how much your insurance pays for that particular treatment is important. Speak to your treatment coordinator at the Houston dental office if you have any questions concerning your coverage.